|
| |
|
29 Bruin Dr Wellsburg WV 26070-3064 | |
| (047) 977-7333 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
| Location | 29 Bruin Dr, Wellsburg, West Virginia |
| Authorized Official Name and Position | Judy L Raveaux (CEO) |
| Authorized Official Contact | 3047977733 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
3158 West St Weirton WV 26062-4637 Ph: (130) 479-7773 | 29 Bruin Dr Wellsburg WV 26070-3064 Ph: (047) 977-7333 |
| NPI Number | 1063918472 |
|---|---|
| Provider Enumeration Date | 04/04/2018 |
| Last Update Date | 04/04/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1063918472 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | 2271-6959 (West Virginia) | Primary |
Joseph J Depetro Iii Md Professional Corporation Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 69 8th St, Wellsburg, WV 26070 Phone: 304-737-0321 Fax: 304-737-2979 | |
Edward Robert Marks Iii Md Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1006 Commerce St, Wellsburg, WV 26070 Phone: 304-737-4435 Fax: 304-737-4439 | |
Wheeling Hospital, Inc. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1006 Commerce St, Wellsburg, WV 26070 Phone: 304-737-4435 Fax: 304-737-4439 |